Like a Natural WomanWhat's the real story behind period-suppressing contraceptives?

By Ann Friedman

When Lybrel, a brand of
birth control pill that stops
monthly menstruation, became
available in July, many women
expressed skepticism that suppressing
a regular bodily function could come
without serious side effects. The media
quickly latched onto this attitude,
with headlines such as “Many
Young Women Wary of a Life
Without Periods.” One woman
told The New York Times she
was worried by “the idea that
you can turn your body on and
off like a tap.”

A debate over period suppression
also erupted among
feminists. Some worried that
this new type of pill would
pathologize menstruation—
sending the message that a
normal female bodily function
is something that needs treatment,
and not just if you have
“problem” periods. They argued
that, like everything
from bikini waxes to plastic
surgery, period suppression
reinforces the message that
women need to tame their
bodies.

Yet, despite the blogging and
the headlines, two-thirds of
U.S. women surveyed said they are interested
in such pills. More importantly,
a whopping 97 percent of physicians
surveyed said period suppression is
medically safe and acceptable.

In fact, criticism over manipulating
a woman’s period can apply to all hormonal
birth control methods, because
everything from the Pill to the
patch to the ring to Lybrel regulates
the menstrual cycle. And calling it
unnatural to manipulate a woman’s
cycle can be a slippery slope: What is
natural, anyway? In premodern societies,
women were pregnant or
breastfeeding for a much larger portion
of their lives—which were shorter,
anyway, and often ended in death
during childbirth. Today, we have between
350 and 400 times as many periods
as our premodern sisters did.
Furthermore, as feminist blogger
Amanda Marcotte (Pandagon) pointed
out, adopting the natural/unnatural
framework sounds awfully similar to
right-wing claims that everything
from women CEOs to same-sex relationships
is unnatural.

This isn’t a new conversation:
The idea of “natural” birth control
has been a theme of the contraceptive
movement for decades, although
the word has taken on different
meanings. With the advent of Lybrel
and other period-suppressing
oral contraceptives such as
Seasonale and Seasonique, it’s
not surprising that we are
once again considering the
nature of natural.

It’s almost common knowledge
that the reason the original
birth control pills,
approved by the FDA in 1960,
attempted to mimic a woman’s
28-day menstrual cycle is that
one of the men who developed
the Pill, a researcher named
John Rock, wanted to convince
the Catholic Church that hormonal
contraception could be
“natural.” And indeed, that’s
part of the story. But it wasn’t
just to please the pope.

Rock created a 28-day regimen
to convince himself. As
Malcolm Gladwell wrote in a
2000 issue of The New Yorker,
Rock, a devout Catholic, believed
(as the church did) that the
only natural method of contraception
was for a woman to abstain from sex
when she was fertile. During the rest
of her cycle, and when pregnant or
breastfeeding, a woman produces the
hormone progesterone to keep her
ovaries from releasing an egg (although
a woman can get pregnant while breastfeeding). Rock thought
that if he could simply extend this
infertile period by giving women
progesterone—the combination oral
contraceptive also contains estrogen—
he would have a contraceptive
method that complied with church
teachings.

There were other key reasons for
keeping the 28-day cycle, says Carl
Djerassi, a chemist whose research
led to the development of the Pill:
“At that time, giving a woman the assurance
that she was not pregnant—
remember there were no home
pregnancy kits—was indispensable,
and the only way a woman was certain
was to experience the usual monthly
period.”

Even though the chemical composition
of the Pill has been tweaked
over time—becoming safer and using
fewer hormones—that original cycle
of 21 days of progesterone and estrogen
followed by a week of placebos or
no pills (thus allowing the bloody inner
lining of the uterus to slough off)
has persisted. So, too, has the perception
that this somehow creates natural
birth control—or as natural as
possible for a contraceptive method
using synthetic hormones.

That view persisted until November
2003 when Seasonale, the first
oral contraceptive to promise women
only four periods a year, hit the market.
The drug works exactly the same
as the 28-day regimen; in fact, since
the 1960s some doctors had been prescribing
continuous use of the Pill
(telling women to skip the week of
placebo pills) to help with medical
conditions such as menstrual migraines,
endometriosis, anemia and
mood fluctuations due to hormonal
changes, and even to help women
avoid having their periods at inconvenient
times (such as during a special
event). Because the uterine lining
does not build up as quickly for
women on the Pill, there’s actually no
medical need to slough it off every
three weeks. When the woman has
her period, it’s because her body has
responded to the withdrawal of progesterone,
not because her uterine lining
needs to be shed.

When it came time to market these
period-suppressing pills, Big Pharma
rolled out multimillion-dollar ad
campaigns selling the idea that
monthly periods hold us back from
being truly happy and fulfilled.
“When you think about what women
have accomplished with 13 periods a
year, think about what we can accomplish
with only four,” said Sex and the
City author Candace Bushnell in a
2003 ad for Seasonale.

It was this “periods cramp your
style” message that prompted the Society
for Menstrual Cycle Research
to release this statement in 2007:
“While we recognize that cycle-stopping
contraception may be useful for
some medical conditions (such as severe
endometriosis), we caution
against its use as ‘a lifestyle choice’
until safety is firmly established. Historically,
nasty surprises with hormonal
therapies for women…have
taken many years to surface.”

But the pills also have several discernible
medical benefits. Having
fewer ovulatory cycles means less regeneration
of ovarian and uterine
cells, and thereby lowers risk for
ovarian and uterine cancers. Avoiding
ovulation can also hinder the
progress of endometriosis, and resting
a woman’s ovaries can lower her
chance of developing ovarian cysts. In
fact, the main complaint about the
period-suppressing pill—other than
the similar side effects experienced by
women on the 28-day oral contraceptives—
has been breakthrough bleeding.
Long gone are the days of the
earliest formulation of Rock’s birth
control pills, which had 50 percent
more estrogen and a much higher
risk of heart disease and stroke.

Of course, some of the most conservative
anti-choicers would say the
real problem here is that women no
longer spend enough time in the
“natural” state of pregnancy. Leslee
Unruh, the South Dakota anti-choice
activist who is responsible for pushing
everything from abortion bans to
abstinence-only education, warned
on Fox News that Lybrel was a “war
on women and children” and a “pesticide.”
She described those in favor of
FDA approval as “wanting us women
who are feminine and have fertility…
to be like men.” (Obviously, this is
not a view shared by many American
women, 98 percent of whom will use
some form of contraception during
their lifetime.)

This gets to the heart of why “it’s
not natural” is an ineffective argument
against period suppression. To
some feminists, natural may mean a
menstrual cycle unchanged by pharmaceuticals
(but we’re not giving up
our cramps-reducing Advil!); to
anti-choicers like Unruh, it means
women maintaining roles as fulltime
child-bearers and caregivers.
So if you’re a feminist who opposes
period-suppressing pills, critique Big
Pharma. Or, if there are dangers found
by researchers, pass the information
along. But please, don’t attempt to
once again define “natural.”

ANN FRIEDMAN is deputy editor of The
American Prospect and one of the editors
of Feministing.com.